Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis

Adam Fang, Sean Studer, Steven M. Kawut, Vivek N. Ahya, James Lee, Keith Wille, Vibha Lama, Lorraine Ware, Jonathan B Orens, Ann Weinacker, Scott M. Palmer, Maria Crespo, David J. Lederer, Clifford S. Deutschman, Benjamin A. Kohl, Scarlett Bellamy, Ejigayehu Demissie, Jason D. Christie

Research output: Contribution to journalArticle

Abstract

Background: Idiopathic pulmonary fibrosis(IPF)is often associated with elevations in pulmonary artery pressures. Although primary pulmonary arterial hypertension (PAH) has been associated with primary graft dysfunction (PGD), the role of secondary PAH in mediating PGD risk in patients with IPF is incompletely understood. The purpose of this study was to evaluate the relationship between mean pulmonary artery pressure(mPAP)and PGD among patients with IPF. Methods: We performed a multicenter prospective cohort study of 126 lung transplant procedures performed for IPF between March 2002 and August 2007. The primary outcome was grade 3 PGD at 72 h after lung transplant. The mPAP was measured as the initial reading following insertion of the right-sided heart catheter during lung transplant. Multivariable logistic regression was used to adjust for confounding variables. Results: The mPAP for patients with PGD was 38.5 ± 16.3 mm Hg vs 29.6 ± 11.5 mm Hg for patients without PGD (mean difference, 8.9 mm Hg [95% CI, 3.6-14.2]; P =.001). The increase in odds of PGD associated with each 10-mm Hg increase in mPAP was 1.64 (95% CI, 1.18-2.26; P =.003). In multivariable models, this relationship was independent of confounding by other clinical variables, although the use of cardiopulmonary bypass partially attenuated the relationship. Conclusions: Higher mPAP in patients with IPF is associated with the development of PGD.

Original languageEnglish (US)
Pages (from-to)782-787
Number of pages6
JournalChest
Volume139
Issue number4
DOIs
StatePublished - Apr 2011

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Primary Graft Dysfunction
Idiopathic Pulmonary Fibrosis
Lung Transplantation
Pulmonary Artery
Pressure
Transplants
Lung
Cardiac Catheters
Confounding Factors (Epidemiology)
Cardiopulmonary Bypass
Pulmonary Hypertension
Reading
Cohort Studies
Logistic Models
Prospective Studies

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis. / Fang, Adam; Studer, Sean; Kawut, Steven M.; Ahya, Vivek N.; Lee, James; Wille, Keith; Lama, Vibha; Ware, Lorraine; Orens, Jonathan B; Weinacker, Ann; Palmer, Scott M.; Crespo, Maria; Lederer, David J.; Deutschman, Clifford S.; Kohl, Benjamin A.; Bellamy, Scarlett; Demissie, Ejigayehu; Christie, Jason D.

In: Chest, Vol. 139, No. 4, 04.2011, p. 782-787.

Research output: Contribution to journalArticle

Fang, A, Studer, S, Kawut, SM, Ahya, VN, Lee, J, Wille, K, Lama, V, Ware, L, Orens, JB, Weinacker, A, Palmer, SM, Crespo, M, Lederer, DJ, Deutschman, CS, Kohl, BA, Bellamy, S, Demissie, E & Christie, JD 2011, 'Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis', Chest, vol. 139, no. 4, pp. 782-787. https://doi.org/10.1378/chest.09-2806
Fang, Adam ; Studer, Sean ; Kawut, Steven M. ; Ahya, Vivek N. ; Lee, James ; Wille, Keith ; Lama, Vibha ; Ware, Lorraine ; Orens, Jonathan B ; Weinacker, Ann ; Palmer, Scott M. ; Crespo, Maria ; Lederer, David J. ; Deutschman, Clifford S. ; Kohl, Benjamin A. ; Bellamy, Scarlett ; Demissie, Ejigayehu ; Christie, Jason D. / Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis. In: Chest. 2011 ; Vol. 139, No. 4. pp. 782-787.
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abstract = "Background: Idiopathic pulmonary fibrosis(IPF)is often associated with elevations in pulmonary artery pressures. Although primary pulmonary arterial hypertension (PAH) has been associated with primary graft dysfunction (PGD), the role of secondary PAH in mediating PGD risk in patients with IPF is incompletely understood. The purpose of this study was to evaluate the relationship between mean pulmonary artery pressure(mPAP)and PGD among patients with IPF. Methods: We performed a multicenter prospective cohort study of 126 lung transplant procedures performed for IPF between March 2002 and August 2007. The primary outcome was grade 3 PGD at 72 h after lung transplant. The mPAP was measured as the initial reading following insertion of the right-sided heart catheter during lung transplant. Multivariable logistic regression was used to adjust for confounding variables. Results: The mPAP for patients with PGD was 38.5 ± 16.3 mm Hg vs 29.6 ± 11.5 mm Hg for patients without PGD (mean difference, 8.9 mm Hg [95{\%} CI, 3.6-14.2]; P =.001). The increase in odds of PGD associated with each 10-mm Hg increase in mPAP was 1.64 (95{\%} CI, 1.18-2.26; P =.003). In multivariable models, this relationship was independent of confounding by other clinical variables, although the use of cardiopulmonary bypass partially attenuated the relationship. Conclusions: Higher mPAP in patients with IPF is associated with the development of PGD.",
author = "Adam Fang and Sean Studer and Kawut, {Steven M.} and Ahya, {Vivek N.} and James Lee and Keith Wille and Vibha Lama and Lorraine Ware and Orens, {Jonathan B} and Ann Weinacker and Palmer, {Scott M.} and Maria Crespo and Lederer, {David J.} and Deutschman, {Clifford S.} and Kohl, {Benjamin A.} and Scarlett Bellamy and Ejigayehu Demissie and Christie, {Jason D.}",
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T1 - Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis

AU - Fang, Adam

AU - Studer, Sean

AU - Kawut, Steven M.

AU - Ahya, Vivek N.

AU - Lee, James

AU - Wille, Keith

AU - Lama, Vibha

AU - Ware, Lorraine

AU - Orens, Jonathan B

AU - Weinacker, Ann

AU - Palmer, Scott M.

AU - Crespo, Maria

AU - Lederer, David J.

AU - Deutschman, Clifford S.

AU - Kohl, Benjamin A.

AU - Bellamy, Scarlett

AU - Demissie, Ejigayehu

AU - Christie, Jason D.

PY - 2011/4

Y1 - 2011/4

N2 - Background: Idiopathic pulmonary fibrosis(IPF)is often associated with elevations in pulmonary artery pressures. Although primary pulmonary arterial hypertension (PAH) has been associated with primary graft dysfunction (PGD), the role of secondary PAH in mediating PGD risk in patients with IPF is incompletely understood. The purpose of this study was to evaluate the relationship between mean pulmonary artery pressure(mPAP)and PGD among patients with IPF. Methods: We performed a multicenter prospective cohort study of 126 lung transplant procedures performed for IPF between March 2002 and August 2007. The primary outcome was grade 3 PGD at 72 h after lung transplant. The mPAP was measured as the initial reading following insertion of the right-sided heart catheter during lung transplant. Multivariable logistic regression was used to adjust for confounding variables. Results: The mPAP for patients with PGD was 38.5 ± 16.3 mm Hg vs 29.6 ± 11.5 mm Hg for patients without PGD (mean difference, 8.9 mm Hg [95% CI, 3.6-14.2]; P =.001). The increase in odds of PGD associated with each 10-mm Hg increase in mPAP was 1.64 (95% CI, 1.18-2.26; P =.003). In multivariable models, this relationship was independent of confounding by other clinical variables, although the use of cardiopulmonary bypass partially attenuated the relationship. Conclusions: Higher mPAP in patients with IPF is associated with the development of PGD.

AB - Background: Idiopathic pulmonary fibrosis(IPF)is often associated with elevations in pulmonary artery pressures. Although primary pulmonary arterial hypertension (PAH) has been associated with primary graft dysfunction (PGD), the role of secondary PAH in mediating PGD risk in patients with IPF is incompletely understood. The purpose of this study was to evaluate the relationship between mean pulmonary artery pressure(mPAP)and PGD among patients with IPF. Methods: We performed a multicenter prospective cohort study of 126 lung transplant procedures performed for IPF between March 2002 and August 2007. The primary outcome was grade 3 PGD at 72 h after lung transplant. The mPAP was measured as the initial reading following insertion of the right-sided heart catheter during lung transplant. Multivariable logistic regression was used to adjust for confounding variables. Results: The mPAP for patients with PGD was 38.5 ± 16.3 mm Hg vs 29.6 ± 11.5 mm Hg for patients without PGD (mean difference, 8.9 mm Hg [95% CI, 3.6-14.2]; P =.001). The increase in odds of PGD associated with each 10-mm Hg increase in mPAP was 1.64 (95% CI, 1.18-2.26; P =.003). In multivariable models, this relationship was independent of confounding by other clinical variables, although the use of cardiopulmonary bypass partially attenuated the relationship. Conclusions: Higher mPAP in patients with IPF is associated with the development of PGD.

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JO - Chest

JF - Chest

SN - 0012-3692

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